| NPI | 1326205428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 58881) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 22116) |
| Enumeration Date | 2008-05-18 |
| Last Update Date | 2009-12-04 |